[United States Senate Manual, 117th Congress]
[S. Doc. 117-1]
[Cleaves Manual of Conferences and Conference Reports]
[Pages 437-444]
[From the U.S. Government Publishing Office, www.gpo.gov]


[[Page 437]]
 
                            TITLE 38--VETERANS' BENEFITS

            
            Chapter 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL 
                                        CARE

       383  Sec. 1703E. Center for Innovation for Care and Payment
                (a) In General.--(1) There is established within the 
            Department a Center for Innovation for Care and Payment (in 
            this section referred to as the ``Center'').
                (2) The Secretary, acting through the Center, may carry 
            out such pilot programs the Secretary determines to be 
            appropriate to develop innovative approaches to testing 
            payment and service delivery models in order to reduce 
            expenditures while preserving or enhancing the quality of 
            care furnished by the Department.
                (3) The Secretary, acting through the Center, shall test 
            payment and service delivery models to determine whether 
            such models--
                            (A) improve access to, and quality, 
                        timeliness, and patient satisfaction of care and 
                        services; and
                            (B) create cost savings for the Department.
                (4)(A) The Secretary shall test a model in a location 
            where the Secretary determines that the model will addresses 
            deficits in care (including poor clinical outcomes or 
            potentially avoidable expenditures) for a defined 
            population.
                (B) The Secretary shall focus on models the Secretary 
            expects to reduce program costs while preserving or 
            enhancing the quality of care received by individuals 
            receiving benefits under this chapter.
                (C) The models selected may include those described in 
            section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 
            1315a(b)(2)(B)).
                (5) In selecting a model for testing, the Secretary may 
            consider, in addition to other factors identified in this 
            subsection, the following factors:
                            (A) Whether the model includes a regular 
                        process for monitoring and updating patient care 
                        plans in a manner that is consistent with the 
                        needs and preferences of individuals receiving 
                        benefits under this chapter.
                            (B) Whether the model places the individual 
                        receiving benefits under this chapter (including 
                        family members and other caregivers of such 
                        individual) at the center of the care team of 
                        such individual.
                            (C) Whether the model uses technology or new 
                        systems to coordinate care over time and across 
                        settings.
                            (D) Whether the model demonstrates effective 
                        linkage with other public sector payers, private 
                        sector payers, or statewide payment models.
                (6)(A) Models tested under this section may not be 
            designed in such a way that would allow the United States to 
            recover or collect reasonable charges from a Federal health 
            care program for care or services furnished by the Secretary 
            to a veteran under pilot programs carried out under this 
            section.

[[Page 438]]

                (B) In this paragraph, the term ``Federal health care 
            program'' means--

                                (i) an insurance program described in 
                            section 1811 of the Social Security Act (42 
                            U.S.C. 1395c) or established by section 1831 
                            of such Act (42 U.S.C. 1395j);

                                (ii) a State plan for medical assistance 
                            approved under title XIX of such Act (42 
                            U.S.C. 1396 et seq.); or

                                (iii) a TRICARE program operated under 
                            sections 1075, 1075a, 1076, 1076a, 1076c, 
                            1076d, 1076e, or 1076f of title 10.

                (b) Duration.--Each pilot program carried out by the 
            Secretary under this section shall terminate no later than 5 
            years after the date of the commencement of the pilot 
            program.
                (c) Location.--The Secretary shall ensure that each 
            pilot program carried out under this section occurs in an 
            area or areas appropriate for the intended purposes of the 
            pilot program. To the extent practicable, the Secretary 
            shall ensure that the pilot programs are located in 
            geographically diverse areas of the United States.
                (d) Budget.--Funding for each pilot program carried out 
            by the Secretary under this section shall come from 
            appropriations--
                            (1) provided in advance in appropriations 
                        acts for the Veterans Health Administration; and
                            (2) provided for information technology 
                        systems.
                (e) Notice.--The Secretary shall--
                            (1) publish information about each pilot 
                        program under this section in the Federal 
                        Register; and
                            (2) take reasonable actions to provide 
                        direct notice to veterans eligible to 
                        participate in such pilot programs.
                (f) Waiver of Authorities.--(1) Subject to reporting 
            under paragraph (2) and approval under paragraph (3), in 
            implementing a pilot program under this section, the 
            Secretary may waive such requirements in subchapters I, II, 
            and III of this chapter as the Secretary determines 
            necessary solely for the purposes of carrying out this 
            section with respect to testing models described in 
            subsection (a).
                (2) Before waiving any authority under paragraph (1), 
            the Secretary shall submit to the Speaker of the House of 
            Representatives, the minority leader of the House of 
            Representatives, the majority leader of the Senate, the 
            minority leader of the Senate, and each standing committee 
            with jurisdiction under the rules of the Senate and of the 
            House of Representatives to report a bill to amend the 
            provision or provisions of law that would be waived by the 
            Department, a report on a request for waiver that describes 
            in detail the following:
                            (A) The specific authorities to be waived 
                        under the pilot program.
                            (B) The standard or standards to be used in 
                        the pilot program in lieu of the waived 
                        authorities.
                            (C) The reasons for such waiver or waivers.
                            (D) A description of the metric or metrics 
                        the Secretary will use to determine the effect 
                        of the waiver or waivers upon the access to and 
                        quality, timeliness, or patient satisfaction of 
                        care and services furnished through the pilot 
                        program.
                            (E) The anticipated cost savings, if any, of 
                        the pilot program.
                            (F) The schedule for interim reports on the 
                        pilot program describing the results of the 
                        pilot program so far and the feasibility and 
                        advisability of continuing the pilot program.

[[Page 439]]

                            (G) The schedule for the termination of the 
                        pilot program and the submission of a final 
                        report on the pilot program describing the 
                        result of the pilot program and the feasibility 
                        and advisability of making the pilot program 
                        permanent.
                            (H) The estimated budget of the pilot 
                        program.
                (3)(A) Upon receipt of a report submitted under 
            paragraph (2), each House of Congress shall provide copies 
            of the report to the chairman and ranking member of each 
            standing committee with jurisdiction under the rules of the 
            House of Representatives or the Senate to report a bill to 
            amend the provision or provisions of law that would be 
            waived by the Department under this subsection.
                (B) The waiver requested by the Secretary under 
            paragraph (2) shall be considered approved under this 
            paragraph if there is enacted into law a joint resolution 
            approving such request in its entirety.
                (C) For purposes of this paragraph, the term ``joint 
            resolution'' means only a joint resolution which is 
            introduced within the period of five legislative days 
            beginning on the date on which the Secretary transmits the 
            report to the Congress under such paragraph (2), and--

                                (i) which does not have a preamble; and

                                (ii) the matter after the resolving 
                            clause of which is as follows: ``that 
                            Congress approves the request for a waiver 
                            under section 1703E(f) of title 38, United 
                            States Code, as submitted by the Secretary 
                            on_____'', the blank space being filled with 
                            the appropriate date.

                (D)(i) Any committee of the House of Representatives to 
            which a joint resolution is referred shall report it to the 
            House without amendment not later than 15 legislative days 
            after the date of introduction thereof. If a committee fails 
            to report the joint resolution within that period, the 
            committee shall be discharged from further consideration of 
            the joint resolution.
                (ii) It shall be in order at any time after the third 
            legislative day after each committee authorized to consider 
            a joint resolution has reported or has been discharged from 
            consideration of a joint resolution, to move to proceed to 
            consider the joint resolution in the House. All points of 
            order against the motion are waived. Such a motion shall not 
            be in order after the House has disposed of a motion to 
            proceed on a joint resolution addressing a particular 
            submission. The previous question shall be considered as 
            ordered on the motion to its adoption without intervening 
            motion. The motion shall not be debatable. A motion to 
            reconsider the vote by which the motion is disposed of shall 
            not be in order.
                (iii) The joint resolution shall be considered as read. 
            All points of order against the joint resolution and against 
            its consideration are waived. The previous question shall be 
            considered as ordered on the joint resolution to its passage 
            without intervening motion except two hours of debate 
            equally divided and controlled by the proponent and an 
            opponent. A motion to reconsider the vote on passage of the 
            joint resolution shall not be in order.
                (E)(i) A joint resolution introduced in the Senate shall 
            be referred to the Committee on Veterans' Affairs.
                (ii) Any committee of the Senate to which a joint 
            resolution is referred shall report it to the Senate without 
            amendment not later than 15 session days after the date of 
            introduction of a joint resolution described

[[Page 440]]

            in paragraph (C). If a committee fails to report the joint 
            resolution within that period, the committee shall be 
            discharged from further consideration of the joint 
            resolution and the joint resolution shall be placed on the 
            calendar.
                (iii)(I) Notwithstanding Rule XXII of the Standing Rules 
            of the Senate, it is in order at any time after the third 
            session day on which the Committee on Veterans' Affairs has 
            reported or has been discharged from consideration of a 
            joint resolution described in paragraph (C) (even though a 
            previous motion to the same effect has been disagreed to) to 
            move to proceed to the consideration of the joint 
            resolution, and all points of order against the joint 
            resolution (and against consideration of the joint 
            resolution) are waived. The motion to proceed is not 
            debatable. The motion is not subject to a motion to 
            postpone. A motion to reconsider the vote by which the 
            motion is agreed to or disagreed to shall not be in order. 
            If a motion to proceed to the consideration of the 
            resolution is agreed to, the joint resolution shall remain 
            the unfinished business until disposed of.
                (II) Consideration of the joint resolution, and on all 
            debatable motions and appeals in connection therewith, shall 
            be limited to not more than two hours, which shall be 
            divided equally between the majority and minority leaders or 
            their designees. A motion further to limit debate is in 
            order and not debatable. An amendment to, or a motion to 
            postpone, or a motion to proceed to the consideration of 
            other business, or a motion to recommit the joint resolution 
            is not in order.
                (III) If the Senate has voted to proceed to a joint 
            resolution, the vote on passage of the joint resolution 
            shall occur immediately following the conclusion of 
            consideration of the joint resolution, and a single quorum 
            call at the conclusion of the debate if requested in 
            accordance with the rules of the Senate.
                (IV) Appeals from the decisions of the Chair relating to 
            the application of the rules of the Senate, as the case may 
            be, to the procedure relating to a joint resolution shall be 
            decided without debate.
                (F) A joint resolution considered pursuant to this 
            paragraph shall not be subject to amendment in either the 
            House of Representatives or the Senate.
                (G)(i) If, before the passage by one House of the joint 
            resolution of that House, that House receives the joint 
            resolution from the other House, then the following 
            procedures shall apply:
                            (I) The joint resolution of the other House 
                        shall not be referred to a committee.
                            (II) With respect to the joint resolution of 
                        the House receiving the joint resolution--

                                        (aa) the procedure in that House 
                                    shall be the same as if no joint 
                                    resolution had been received from 
                                    the other House; but

                                        (bb) the vote on passage shall 
                                    be on the joint resolution of the 
                                    other House.

                (ii) If the Senate fails to introduce or consider a 
            joint resolution under this paragraph, the joint resolution 
            of the House shall be entitled to expedited floor procedures 
            under this subparagraph.
                (iii) If, following passage of the joint resolution in 
            the Senate, the Senate then receives the companion measure 
            from the House of Representatives, the companion measure 
            shall not be debatable.

[[Page 441]]

                (H) This subparagraph is enacted by Congress--
                            (i) as an exercise of the rulemaking power 
                        of the Senate and House of Representatives, 
                        respectively, and as such it is deemed a part of 
                        the rules of each House, respectively, but 
                        applicable only with respect to the procedure to 
                        be followed in that House in the case of a joint 
                        resolution, and it supersedes other rules only 
                        to the extent that it is inconsistent with such 
                        rules; and
                            (ii) with full recognition of the 
                        constitutional right of either House to change 
                        the rules (so far as relating to the procedure 
                        of that House) at any time, in the same manner, 
                        and to the same extent as in the case of any 
                        other rule of that House. (Pub. L. 115-182, 
                        Title I, Sec. 152(a), June 6, 2018, 132 Stat. 
                        1432.)

                                    * * * * * * *

            
               Chapter 81--ACQUISITION AND OPERATION OF HOSPITAL AND 
           DOMICILIARY FACILITIES; PROCUREMENT AND SUPPLY; ENHANCED-USE 
                              LEASES OF REAL PROPERTY

       384  38 U.S.C. 8122 note. VA asset and infrastructure review

                                    * * * * * * *

                ``SEC. 204. ACTIONS REGARDING INFRASTRUCTURE AND 
            FACILITIES OF THE VETERANS HEALTH ADMINISTRATION.
                ``(a) In General.--Subject to subsection (b), the 
            Secretary shall begin to implement the recommended 
            modernizations and realignments in the report under section 
            203(d) not later than 3 years after the date on which the 
            President transmits such report to Congress. In any fiscal 
            year, such implementation includes--
                            ``(1) the planning of modernizations and 
                        realignments of facilities of the Veterans 
                        Health Administration as recommended in such 
                        report; and
                            ``(2) providing detailed information on the 
                        budget for such modernizations or realignments 
                        in documents submitted to Congress by the 
                        Secretary in support of the President's budget 
                        for that fiscal year.
                ``(b) Congressional Disapproval.--
                            ``(1) In general.--The Secretary may not 
                        carry out any modernization or realignment 
                        recommended by the Commission in a report 
                        transmitted from the President pursuant to 
                        section 203(d) if a joint resolution is enacted, 
                        in accordance with the provisions of section 
                        207, disapproving such recommendations of the 
                        Commission before the earlier of--

                                ``(A) the end of the 45-day period 
                            beginning on the date on which the President 
                            transmits such report; or

                                ``(B) the adjournment of Congress sine 
                            die for the session during which such report 
                            is transmitted.

                            ``(2) Computation of period.--For purposes 
                        of paragraph (1) and subsections (a) and (c) of 
                        section 207, the days on which either House of 
                        Congress is not in session because of an 
                        adjournment of more than three days to a day 
                        certain shall be excluded in the computation of 
                        a period.

                                    * * * * * * *

[[Page 442]]

                ``SEC. 207. CONGRESSIONAL CONSIDERATION OF COMMISSION 
            REPORT.
                ``(a) Disapproval Resolution.--For purposes of this 
            subtitle, the term `joint resolution' means only a joint 
            resolution which is introduced within the 5-day period 
            beginning on the date on which the President transmits the 
            report to the Congress under section 203(d), and--
                            ``(1) which does not have a preamble;
                            ``(2) the matter after the resolving clause 
                        of which is as follows: `that Congress 
                        disapproves the recommendations of the VHA Asset 
                        and Infrastructure Review Commission as 
                        submitted by the President on_____', the blank 
                        space being filled with the appropriate date; 
                        and
                            ``(3) the title of which is as follows: 
                        `Joint resolution disapproving the 
                        recommendations of the VHA Asset and 
                        Infrastructure Review Commission.'.
                ``(b) Consideration in the House of Representatives.--
                            ``(1) Reporting and discharge.--Any 
                        committee of the House of Representatives to 
                        which a joint resolution is referred shall 
                        report it to the House without amendment not 
                        later than 15 legislative days after the date of 
                        introduction thereof. If a committee fails to 
                        report the joint resolution within that period, 
                        the committee shall be discharged from further 
                        consideration of the joint resolution.
                            ``(2) Proceeding to consideration.--It shall 
                        be in order at any time after the third 
                        legislative day after each committee authorized 
                        to consider a joint resolution has reported or 
                        has been discharged from consideration of a 
                        joint resolution, to move to proceed to consider 
                        the joint resolution in the House.
                            All points of order against the motion are 
                        waived. Such a motion shall not be in order 
                        after the House has disposed of a motion to 
                        proceed on a joint resolution addressing a 
                        particular submission. The previous question 
                        shall be considered as ordered on the motion to 
                        its adoption without intervening motion. The 
                        motion shall not be debatable. A motion to 
                        reconsider the vote by which the motion is 
                        disposed of shall not be in order.
                            ``(3) Consideration.--The joint resolution 
                        shall be considered as read. All points of order 
                        against the joint resolution and against its 
                        consideration are waived. The previous question 
                        shall be considered as ordered on the joint 
                        resolution to its passage without intervening 
                        motion except 2 hours of debate equally divided 
                        and controlled by the proponent and an opponent. 
                        A motion to reconsider the vote on passage of 
                        the joint resolution shall not be in order.
                ``(c) Consideration in the Senate.--
                            ``(1) Referral.--A joint resolution 
                        introduced in the Senate shall be referred to 
                        the Committee on Veterans' Affairs.
                            ``(2) Reporting and discharge.--Any 
                        committee of the Senate to which a joint 
                        resolution is referred shall report it to the 
                        Senate without amendment not later than 15 
                        session days after the date of introduction of a 
                        joint resolution described in subsection (a). If 
                        a committee fails to report the joint resolution 
                        within that period, the committee shall be 
                        discharged from further consideration of the 
                        joint resolution and the joint resolution shall 
                        be placed on the calendar.
                            ``(3) Floor consideration.--

[[Page 443]]

                                ``(A) In general.--Notwithstanding Rule 
                            XXII of the Standing Rules of the Senate, it 
                            is in order at any time after the third 
                            session day on which the Committee on 
                            Veterans' Affairs has reported or has been 
                            discharged from consideration of a joint 
                            resolution described in subsection (a) (even 
                            though a previous motion to the same effect 
                            has been disagreed to) to move to proceed to 
                            the consideration of the joint resolution, 
                            and all points of order against the joint 
                            resolution (and against consideration of the 
                            joint resolution) are waived. The motion to 
                            proceed is not debatable. The motion is not 
                            subject to a motion to postpone. A motion to 
                            reconsider the vote by which the motion is 
                            agreed to or disagreed to shall not be in 
                            order. If a motion to proceed to the 
                            consideration of the resolution is agreed 
                            to, the joint resolution shall remain the 
                            unfinished business until disposed of.

                                ``(B) Consideration.--Consideration of 
                            the joint resolution, and on all debatable 
                            motions and appeals in connection therewith, 
                            shall be limited to not more than 2 hours, 
                            which shall be divided equally between the 
                            majority and minority leaders or their 
                            designees. A motion further to limit debate 
                            is in order and not debatable. An amendment 
                            to, or a motion to postpone, or a motion to 
                            proceed to the consideration of other 
                            business, or a motion to recommit the joint 
                            resolution is not in order.

                                ``(C) Vote on passage.--If the Senate 
                            has voted to proceed to a joint resolution, 
                            the vote on passage of the joint resolution 
                            shall occur immediately following the 
                            conclusion of consideration of the joint 
                            resolution, and a single quorum call at the 
                            conclusion of the debate if requested in 
                            accordance with the rules of the Senate.

                                ``(D) Rulings of the chair on 
                            procedure.--Appeals from the decisions of 
                            the Chair relating to the application of the 
                            rules of the Senate, as the case may be, to 
                            the procedure relating to a joint resolution 
                            shall be decided without debate.

                ``(d) Amendment Not in Order.--A joint resolution of 
            disapproval considered pursuant to this section shall not be 
            subject to amendment in either the House of Representatives 
            or the Senate.
                ``(e) Coordination With Action by Other House.--
                            ``(1) In general.--If, before the passage by 
                        one House of the joint resolution of that House, 
                        that House receives the joint resolution from 
                        the other House, then the following procedures 
                        shall apply:

                                ``(A) The joint resolution of the other 
                            House shall not be referred to a committee.

                                ``(B) With respect to the joint 
                            resolution of the House receiving the joint 
                            resolution--

                                        ``(i) the procedure in that 
                                    House shall be the same as if no 
                                    joint resolution had been received 
                                    from the other House; but

                                        ``(ii) the vote on passage shall 
                                    be on the joint resolution of the 
                                    other House.

                            ``(2) Treatment of joint resolution of other 
                        house.--If the Senate fails to introduce or 
                        consider a joint resolution under this section, 
                        the joint resolution of the House shall be 
                        entitled to expedited floor procedures under 
                        this section.

[[Page 444]]

                            ``(3) Treatment of companion measures.--If, 
                        following passage of the joint resolution in the 
                        Senate, the Senate then receives the companion 
                        measure from the House of Representatives, the 
                        companion measure shall not be debatable.
                ``(f) Rules of the House of Representatives and 
            Senate.--This section is enacted by Congress--
                            ``(1) as an exercise of the rulemaking power 
                        of the Senate and House of Representatives, 
                        respectively, and as such it is deemed a part of 
                        the rules of each House, respectively, but 
                        applicable only with respect to the procedure to 
                        be followed in that House in the case of a joint 
                        resolution, and it supersedes other rules only 
                        to the extent that it is inconsistent with such 
                        rules; and
                            ``(2) with full recognition of the 
                        constitutional right of either House to change 
                        the rules (so far as relating to the procedure 
                        of that House) at any time, in the same manner, 
                        and to the same extent as in the case of any 
                        other rule of that House. (Pub. L. 115-182, 
                        Title II, Subtitle A, June 6, 2018, 132 Stat. 
                        1443.)
                      42 u.s.c.--the public health and welfare

                   united states senate procedures enacted in law